Key result
Beta blocker withdrawal induced a significant increase in global adenosine myocardial blood flow from 180.2 to 193.6 mL/min/100 g, though MPI interpretation remained unchanged in 90% of cases.
Why the study?
Does beta blocker withdrawal improve global myocardial blood flow and alter clinical interpretation during adenosine myocardial perfusion imaging in patients with CAD?
Observational (n=20)
Single-blind
No
Does beta blocker withdrawal improve global myocardial blood flow and alter clinical interpretation during adenosine myocardial perfusion imaging in patients with CAD?
Absolute Event Rate: 193.6% vs 180.2%
p-value: p=0.02
While beta blocker withdrawal prior to adenosine PET imaging significantly increases myocardial blood flow, it rarely alters the final clinical interpretation, suggesting that testing without withdrawal is acceptable if necessary.
Beta blocker withdrawal rarely alters MPI interpretation despite higher flow; leaves open whether routine withdrawal is needed before adenosine PET.
BACKGROUND: The effect of beta blockers on myocardial blood flow (MBF) under vasodilators has been studied in several SPECT and PET myocardial perfusion imaging (MPI) studies with divergent results. The present study evaluated the effect of a beta blocker withdrawal on quantitative adenosine MBF and on MPI results. METHODS: Twenty patients with beta blockers and CAD history were studied with quantitative adenosine N-13 ammonia PET. The first study was performed under complete medication and the second after beta blocker withdrawal. The PET studies were independently read with respect to MPI result and clinical decision making. RESULTS: Global MBF showed an increase from 180.2 ± 59.9 to 193.6 ± 60.8 mL·minute(-1)/100 g (P = .02) after beta blocker withdrawal. The segmental perfusion values were closely correlated (R(2) = 0.82) over the entire range of perfusion values. An essentially different interpretation after beta blocker discontinuation was found in two cases (10%). CONCLUSION: A beta blocker withdrawal induces an increase in adenosine MBF. In the majority of cases, MPI interpretation and decision making are independent of beta blocker intake. If a temporary beta blocker withdrawal before MPI is not possible or was not realized by the patient, it is appropriate to perform adenosine stress testing without loss of the essential MPI result.
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Hoffmeister et al. (2014) conducted an observational in Coronary Artery Disease (CAD) (n=20). Beta blocker withdrawal vs. Complete medication (with beta blocker) was evaluated on Global myocardial blood flow (MBF) under adenosine (p=0.02). Beta blocker withdrawal induced a significant increase in global adenosine myocardial blood flow from 180.2 to 193.6 mL/min/100 g, though MPI interpretation remained unchanged in 90% of cases.
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